PROMOTING COMMUNITY INTEGRATION VIA A NEW MEDICAID WAIVER SYSTEM

by Shannon A. Laymon-Pecoraro, Esq.

One of the most important benefits received by individuals who are elderly or have a disability are the waiver services provided by Medicaid. For those unfamiliar with waiver services, they are intended to provide standard medical and non-medical services outside of an institutional setting. The coveted waiver programs in Virginia are those provided by the Home and Community Based Services waiver programs, under which individuals may receive support services necessary to promote independent living in his or her home and the community.

While the waiver programs are undoubtedly beneficial, the unfortunate problem with the waiver system is that the need for services in Virginia has surpassed the available funding for the programs, resulting in a large number of citizens being placed on a waiting list for supports, and essentially denying persons with disabilities the ability to integrate within their own community in violation of the “integration mandate” of the Americans with Disabilities Act. As a result, a lawsuit was brought by the United States Department of Justice against the Commonwealth of Virginia and a settlement was reached that requires the Commonwealth of Virginia to promote community integration. The resulting My Life, My Community waiver redesign initiative intends to simplify the currently complex eligibility system, decrease wait times for services, and provide targeted needs-based services that promote choice.

Effective July 2016, the new Building Independence waiver, Family & Individual Supports waiver, and Community Living waivers will replace the current Day Support and Intellectual Disability and Developmental Disability (I/DD) waivers. In contrast to the old system, the new system appears to focus on supports required by the individual and promote the urgency of such supports. The full transition of the new waiver system will be completed by January 2017.

Some key provisions under the new program include:

Both the Family & Individual Supports and the Community Living waivers will allow the recipient to elect an agency-directed (ie: the Community Services Board) or consumer-directed (ie: Moms in Motion or Endependence Center) services, thus promoting choice and improved client service.

Whereas current I/DD eligibility essentially pivots on IQ above or below 70, the new waiver eligibility system will focus on required supports. As a result, persons who were previously on the DD waiver and ineligible for sponsored or group home residential options will now have the option to receive such support, if necessary.

The new waivers intend to promote more integrative services, which will include employment supports, and additional crisis support services.

Only time will tell how successful the new program will be in accomplishing the intended objectives. In the meantime, the attorneys and staff intend to monitor the developments and assist clients with issues that may present during the initial implementation process.

Hook Law Center: Kit Kat, what can you tell us about a recent discovery of a bone fragment from a pregnant Tyrannosaurus rex who existed 68 million years ago?

Kit Kat: Well, paleontologists from North Carolina State University and the North Carolina Museum of Natural Sciences have made some interesting discoveries in Montana. There they found a femur of a t.rex, a type of theropod dinosaur. Theropods have several characteristics, among them a wishbone and air-filled bones. Later, theropods evolved into what we now call birds, in all their varying sizes and shapes. Although the femur was originally found in 2005, recent re-examination of the specimen led to confirmation of their original suspicions that this bone also had with it blood vessels from soft tissue, miraculously preserved all this time.

In the past, scientists have been unable to determine the sex of these prehistoric creatures. However, this particular specimen of medullary bone (the inner part of a bone which houses the marrow) possessed some unique characteristics. So, a chemical analysis of the tissue was done led by Mary Schweitzer of N.C. State. What was found, among other things, was keratin sulfate, an element only found in pregnant female birds. Once the eggs are laid, the substance disappears from the specimen. Next, they compared the specimen from the t.rex, with that of a pregnant ostrich. The tissue of the two different samples were similar; therefore, the conclusion the team reached was that the t.rex was indeed a female, and had been pregnant at the time of death.

This was an amazing discovery for science. According to Lindsay Zanno, co-author of the study from the N.C. Museum of Natural Sciences, heretofore, there just hasn’t been a precise way to distinguish males from females. Although the probability of finding future samples from pregnant specimens is small, the team feels encouraged that they have at least opened the door to research in the study of sex-linked characteristics of extinct dinosaurs. (http://www.washingtonpost.com/news/speaking-of-science/wp/2016/03/15/scientists-believe-they’ve-found-pregnant/T.rex)

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The Hook Law Center (formerly Oast & Hook) offices are located in Virginia Beach, and Suffolk, convenient to the Peninsula, and Southside including the cities of Chesapeake, the Eastern Shore, Franklin, Hampton, Isle of Wight, Newport News, Norfolk, Poquoson, Portsmouth, Richmond, Smithfield, Suffolk, Virginia Beach, Williamsburg, Yorktown and Zuni. Content by elder law attorney, Andrew Hook and the Hook Law Center staff.